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SITE ADDRESS <br />N0. <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8657 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />Y V 1� I I�I�Y 1 V f� <br />5v�oblo�ui:�'i �n�vrjt�SvGy <br />CONTR. LICENSE • <br />USE OF BUILDING <br />WORK DESCRIPTION <br />�ya-i�Za�: <br />N0. I TYPE OF FIXTURE OR �TEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof dreins <br />Other <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION � <br />AUDRESS CI7 <br />OZ Co2�rx �i.J� � <br />CONTACT FOR P IT <br />loDa H{�7� l.(iNikv�� � <br />��� <br />HEATSOURCE <br />�leclric _ Gas _ Other <br />��� p1�7'12�J 1t��2►c.LL ! <br />NO. I <br />PERMIT li <br />\1U1U-CX��\ <br />_r.�i. C ( <br />' �(��5�3 -`�l`l� <br />CONTRACT PRICE OF WORK <br />�✓� � <br />��4x�/ � D 1, � <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />forced air systems <br />Gas piping <br />Water heater <br />Gas 5replace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refngeration <br />Woodstove <br />Other <br />CITY Of EVERETT LOCAL SALES TA% COUE IS 3105 <br />I hereby certify that I have read and ezamined this application and know the same to be true and conect. All provisions of laws and <br />ordinances governing this type of work will be complied wilh whether specifed herein or not. The granting of a pertnit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating consW ction or the performance of <br />construction. That I am authorized by the owner of this property to pertorm the work for which appliwtion is made and I comply with the <br />St�{r,Contradors Law 1827 RCW and 296.200 WAQ , . <br />